Adaptation of Antihypertensive Therapy After Discharge From a Geriatric Unit Following Non-Cardiovascular Hospitalization

Objective: Antihypertensive therapy is frequently modified during hospitalization of older adults with acute non-cardiovascular illness, but its impact after discharge remains insufficiently characterized. This study aimed to characterize antihypertensive therapy adaptation after non-cardiovascular hospitalization in a frail geriatric population and to evaluate its association with outcomes. Design and method: Prospective observational study including patients with known hypertension admitted to a geriatric unit between January and June 2025. Data on comorbidities, frailty, and antihypertensive therapy at admission and discharge were collected. Outcomes included emergency department visits, hospital readmissions and 30-day mortality, as well as falls or cardiovascular events at 6 months. Appropriate statistical tests were applied. Results: A total of 167 hospitalization episodes corresponding to 153 patients were included (mean age 86.7 ± 5.4 years; 32.7% male). The most frequent comorbidities were dyslipidaemia (70.7%), heart failure (50.3%) and diabetes mellitus (41.9%). Most patients had very high cardiovascular risk (60.5%) and were polymedicated (greater than 5 drugs, 95.8%). This was a highly frail population (mRankin greater than4: 69.4%; frailty score greater than6: 67.6%), with a median Barthel Index of 24 [50]. At admission, 25.7% of patients were receiving one antihypertensive drug, 42.7% two drugs and 31.6% three or more drugs (median 2 [2]). At discharge, the median number of antihypertensive drugs was 1 [1], representing a statistically significant reduction compared with pre-admission therapy (Wilcoxon test, p < 0.001). Systolic blood pressure at most 130 mmHg during hospitalization was associated with antihypertensive therapy reduction (p < 0.001). No differences were observed between patients with or without therapy reduction regarding age, functional status, frailty, emergency department visits, hospital readmissions, 30-day mortality, or falls and cardiovascular events at 6 months. Conclusions: In frail older adults hospitalized for non-cardiovascular causes, antihypertensive therapy was frequently and significantly reduced at discharge, mainly associated with lower in-hospital systolic blood pressure values, without increased adverse outcomes up to 6 months. These findings support individualized hypertension management and medication review in the context of acute illness and polypharmacy.